Bekesy Audiometry in
Analysis of Auditory Disorders
JAMES JERGER
Less than 14 years has elapsed since
Bekesy's original description of a self-
recording audiometer (2). Within this
period, however, the technique of
'Bekesy audiometry' has rapidly gained
the stature of a major clinical and
research tool in audiology'.
Bekesy audiometry refers to a
method in which the subject traces his
own auditory threshold by means of
a suitable self-recording audiometer.
The threshold tracing signal may be
either a fixed frequency or a gradually
changing frequency, and the signal
may be either continuous or periodi-
cally interrupted in time, but the
essence of Bekesy's method is, first,
that the signal intensity is always
changing at a constant rate, and second,
that the subject determines the direc-
tion of this change by alternately
pressing and releasing a key that re-
verses the direction of a motor-driven
attenuator. He is instructed to press
this key when he just hears the tone
and to release it when he just-no-longer
James Jerger (Ph.D., Northwestern Uni-
versity, 1954) is Associate Professor of Audi-
ology, Northwestern University. A portion
of this article is based on a paper presented
at the 1959 Convention of the American
Speech and Hearing Association, Cleveland.
This research was supported by research
grant B-1310 from the National Institutes of
Health, Public Health Service, and by the
United States Air Force under Contract
AF 41 (657)-185, monitored by the School of
Aviation Medicine, USAF, Brooks Air Force
Base, Texas.
Volume 3, No. 3
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hears it. By connecting a pen-writing
system to the attenuator a graphic
representation, or tracing, of the sub-
ject's successive threshold crossings
may be obtained.
The Bekesy technique is particu-
larly useful in psychoacoustics. It lends
itself admirably, for example: to the
measurement of temporary threshold
shift following acoustic stimulation
and has been so employed by several
investigators (6, 8, 10, 12, 15, 20, 31,
32, 33, 34). It finds use in the measure-
ment of pure-tone masking (3, Y).
The present paper is concerned, how-
ever, only with Bekesy audiometry as
a clinical tool in the evaluation of the
hearing impaired. In the majority of
papers concerned with the clinical ap-
plication of Bekesy audiometry, meas-
urement and description have been
confined almost exclusively to the
width or amplitude of the audiometric
tracing. This distance or width may
be expressed either in decibels or in
number of threshold crossings over a
given frequency span. In the graphic
form of the Bekesy audiogram it is
most easily visualized as the amplitude
of the oscillating trace. Bekesy (2), in
his original paper, noted that the
amplitude became greatly diminished
in subjects with hearing loss accom-
panied by loudness recruitment. He
assumed that the tracing amplitude
represented the first just-noticeable-
difference (JND) in loudness and con-
275 September 1960
 276 Journal o[ Speech and Hearing Research
cluded that a reduction in its size was
compatible with the presence of an
abnormally rapid rate of loudness
growth with intensity (that is, loud-
ness recruitment). However, Bekesy's
assumption that the amplitude repre-
sents the first JND has been questioned
by Hirsh, Palva, and Goodman (9),
who feel that the amplitude actually
represents the variability about the
absolute threshold.
In any event, subsequent papers on
Bekesy audiometry have dealt primarily
with the amplitude aspect of the audio-
metric tracing (1, 7, 11, 17, 18, 21, 22,
23, 25, 26, 27, 28, 29, 30, 35, 36). The
major point of view in this respect is
best exemplified by the very thorough
monograph of Lundborg (21). This
investigator obtained Bekesy audio-
grams on 50 normals, 25 cases of acous-
tic trauma, 26 cases of Meniere's disease,
and 21 cases of diverse retrocochlear
lesion. He then classified the audiograms
into four types based on the tracing
amplitude. There appeared to be a
rather precise relationship between
type of Bekesy tracing and site of
lesion. Markedly reduced amplitude
was characteristically present in cases
with p r e s u m a b l y c o c h l e a r lesion
(acoustic trauma and Meniere's disease)
but characteristically absent in cases
with retrocochlear lesion.
In recent years increasing attention
has been given to another aspect of the
Bekesy tracing, the change in threshold
intensity over time as the subject traces
threshold at a fixed frequency (4, 14,
16, 19, 26, 27, 28, 37). Kos (16), Lierle
and Reger (19), Jerger, Carhart, and
Lassman (14), and Yantis (37) have
shown very little change over time in
presumably cochlear lesion, but marked
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progression toward higher and higher
threshold intensity over time in retro-
cochlear lesion.
The present paper concerns the rela-
tionship between Bekesy audiometry
and site of lesion within the auditory
system. Unfortunately, almost every
previous writer has confused this issue
with a quite separate question, the re-
lationship between the Bekesy tracing
and the presence or absence of loudness
recruitment. It must be emphasized,
therefore, that the present paper is not
concerned with how Bekesy audiom-
etry relates to loudness recruitment,
only with how it relates to site of
lesion within the auditory system.
Procedure
Subjects. This report is based on the
Bekesy audiograms of 434 subjects
tested at the Hearing Clinic of the
Northwestern U n i v e r s i t y M e d i c a l
School over a three-year period. The
subjects were referred from various
sources for audiological evaluation. The
majority were referred by otologists, a
small number by neurologists and neuro-
surgeons in the Chicago area. Although
no formal attempt at random selection
was made, the series is fairly representa-
tive of the otologic case load in a large
hospital environment. In most cases
Bekesy audiometry was performed as
part of a larger battery of auditory
tests typically administered in a three-
hour test session. Although tracings
were ordinarily obtained on both ears,
subsequent analysis is confined to results
obtained on only one ear of each sub-
ject.
Apparatus. All of the tracings on
which this report is based were ob-
 Jerger: Bekesy Audiometry, Auditory Disorders
tained w i t h a single Bekesy audiometer
(Grason-Stadler, M o d e l E-800). T h e
rate of attenuation change was always
2.5 db per second, and the rate of fre-
q u e n c y change was always one octave
per minute. T h e instrument offered
the option of a test signal that was
either continuous or periodically inter-
r u p t e d in time. In the latter case, the
interruption rate was 2.5 ips.
T h e results r e p o r t e d below involve
t w o kinds of tracing, subsequently re-
ferred to as 'conventional' and 'fixed-
f r e q u e n c y ' tracings. In conventional
tracings, the f r e q u e n c y of the test signal
m o v e d gradually u p w a r d from 100 to
10 000 cps. In fixed-frequency tracings
the f r e q u e n c y was preset and never
changed as the subject traced his thresh-
old over a t hree-mi n u t e period.
In either case, a complete test always
consisted of two separate tracings. In
one the signal was periodically inter-
rupted, in the second it was continuous
in time. Both tracings, i n t e r r u p t e d and
continuous, w ere always made on the
same piece of graph paper wi t h t w o
different colors of ink. It has been
f o u n d convenient to symbolize these
t w o conditions b y the letters T for
i n t e r r u p t e d and 'C' for continuous in
subsequent portions of this report.
Method. A relatively rigidly stand-
ardized p r o c e d u r e of test administra-
tion was initially designed, b u t could
not be followed rigorously in all
subjects due to the occasional subject
whose ability to understand speech was
e x t r e m e l y limited. In a n y event, the
following instructions w e r e used w h e n -
ever verbal c o m m u n i c a t i o n was pos-
sible:
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277
When I put these earphones on, you are
going to hear a beeping sound in your
ear. As long as you don't do anything the
sound will keep getting louder. But you
can make it fade away by holding down
this switch. When you let up on the switch
the sound will get louder again. Now,
here is what I want you to do. Listen
very carefully, and, as soon as you hear
the beeping sound, hold this switch down
until you can't hear it any more. As
soon as the beeping sound is gone, let up
on the switch until it comes back. Then,
as soon as you hear it again, hold the
switch down until it goes away again,
and so forth. The idea is ~o keep going
back and forth from where you can just
hear the beeping sound to where you
can just not hear it any more. Never
let the sound get very loud and never
let it stay away too long. Hold this
switch down as soon as you hear the
sound, then let it up as soon as the sound
is gone.
F o llo win g these instructions a tracing
was made w i t h the periodically inter-
r u p t e d (I) test signal. A t the termina-
tion of this tracing the subject was
reinstructed as follows:
Now we are going to do the same thing
again, but this time the sound will be
steady instead of beeping on and off.
Your job is still the same. Hold the switch
down as soon as you hear the steady
sound, and let it up as soon as the steady
sound goes away.
F o llo win g these instructions a tracing
was made w i t h the continuous (C)
test signal. T h i s test order, interrupted
first and continuous second, was used
in all subjects. Instructions w e r e iden-
tical for either conventional or fixed-
frequency tracings. When verbal
c o m m u n i c a t i o n was not possible, in-
structions we r e effected t h r o u g h pan-
tomime.
Findings
A n initial a t t e m p t was made to ana-
lyse and score these Bekesy audiograms
quantitatively. Various indices, such as
 278 Journal of Speech and Hearing Research
the width of the continuous tracing in
db, the number of threshold crossing
per quarter octave, the difference be-
tween tracing width at high and low
frequencies, the difference between
continuous and interrupted tracing
widths, and the difference between
continuous and interrupted mid-points,
were evaluated, all with exceedingly
discouraging results. It soon became
apparent that the range of individual
variability on any absolute aspect of the
Bekesy audiogram could be quite sub-
stantial. A good example is the width
of the continuous tracing. In most
Meniere's patients it is, to be sure, quite
small at high frequencies. On the other
hand many young adults with oto-
sclerosis show tracing widths consider-
ably narrower than a large number of
older Meniere's patients. There were,
indeed, significant group tendencies in
this quantitative analysis, but the degree
of overlap among groups appeared to
limit severely the use of any quantita-
tive measure as a reliable means of
differentiating site of lesion. A similar
conclusion was reached by Landes (17).
On the other hand, a qualitative
judgment of the patterning or relation-
ship between the interrupted and the
continuous tracings seemed to have
important diagnostic value. There ap-
peared to be a unique relationship be-
tween continuous and interrupted
tracings corresponding to site of lesion
within the auditory system.
One may distinguish four basic types
of relationship, labelled, respectively,
type I, type II, type III, and type IV.
They are illustrated in Figures 1 and
2. Figure 1 shows the four types in the
ease of conventional tracings, Figure
2 the corresponding types in the case
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of fixed-frequency tracings. Through-
out these and subsequent figures, green
denotes the interrupted (I) tracing and
red denotes the continuous (C) tracing.
Type I. The type I relationship is
characterized by an interweaving or
superposition of continuous and inter-
rupted tracings, and by a tracing width
which is constant over frequency and
averages about 10 db. There is, how-
ever, considerable variation about this
mean value. Tracing widths as small as
3 db and as large as 20 db are not un-
common.
In the ease of fixed-frequency trac-
ings, the type I relationship is reflected
in two interweaving, horizontal trac-
ings.
Type lh Type II tracings differ from
type I in two respects. First, the con-
tinuous tracing drops below the inter-
rupted at high frequencies, but never
to a substantial extent. The gap seldom
exceeds 20 db and ordinarily does not
appear at frequencies below 1000 cps.
Second, the width or amplitude of the
continuous tracing is often quite small
(3 to 5 db) in these higher frequencies.
This narrowing of the width or ampli-
tude of the continuous tracing is, of
course, the classical Bekesy sign
thought by many to indicate the pres-
ence of loudness recruitment.
In fixed-frequency tracing the type
II result is quite clear-cut. The inter-
rupted tracing is, again, horizontal and
of normal width, but the continuous
trace drops from 5 to 20 db below the
interrupted, ~vithin the first minute;
thereafter, it maintains a fairly stable
level. There is a reliable difference be-
tween interrupted and continuous trac-
ings but the difference is relatively
small and remains quite constant after
 ]erger: Bekesy Audiometry, Auditory Disorders 279

2O 2O
e~

.E 40

.~ 6(3 60

80 := 80

I00 I00
125 ?.SG 500 IK 2K 4K 8K 1?.5 ?_50 500 IK 2K 4K 8K
Frequency in cps Frequency in cp$

TYPE I TYPE ~"

20 2O

.G
40 v " ~ 40 ., AA,AI AAAAaAA,k~ A 9

I
60 "v vvv [
9 60 VVV ' vVV~SA%
80 %~' = 80

v'~/~ I00
I00
125 250 500 IK 2K 4K 8K 125 250 500 IK ?.K 4K 8K
Frequency in cp$ Frequency in cp$

TYPE lIT TYPE ~Z

FIGURE 1. The four types of conventional Bekesy audiograms. Green represents threshold
tracing for a periodically interrupted tone, red for a continuous tone.
the first 60 seconds of tracing. Further- 150 cps and drop to a level as much
more, the difference appears only at as 40 to 50 db below the interrupted
mid- and high frequencies (that is, tracing. The width of the continuous
above 500 to 1000 cps). tracing ordinarily remains, however,
quite normal.
Type IlL Type III tracings are quite In type III fixed-frequency tracings
dramatic. The continuous tracing drops the interrupted tracing is horizontal but
below the interrupted to a remarkable the continuous drops very rapidly
degree. Furthermore, the two curves and ordinarily does not stabilize at all.
may diverge at relatively low frequen- Typically, the continuous tracing be-
cies (100 to 500 cps). It is not uncom- gins at the same level as the interrupted
mon to observe the continuous tracing but describes a rapidly descending trace
break away at a frequency as low as to the limit of the equipment. A 40-to-

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 280 Journal o[ Speech and Hearing Research

250 4K 250 4K

20 2O
.r
40
~ w w m
.~ 4o
60 W~Vv~
-r
80 8O

I00 I00
0 2 4 6 8 12 0 2 4 6 8
Tune in minutes Time in minutes

TYPE T TYPE 1T

I 1
250 IK 4K 250 4K

20 20
5: .c
_~ 40
Wv~ ] 40 ~/W Wvw V V ~ W
"~ 60 60 ~,A?,,^.,.~JV

80 80

I00
O 2 4 6
t 8
\
I0 12
I00
0 2 4 6 8 IO 12
Time in minutes Tlme~minu~
TYPE ~l" TYPE~
FIGURE 2. The four types of fixed-frequency Bekesy tracings. Green is interrupted; red,
continuous.

50-db drop within as little as 60 seconds resembling a type II in this respect.

is not unusual.
Type IV. Type IV tracings more
closely resemble type II than type III
but differ in one important respect.
The continuous tracing falls consist-
ently below the interrupted at fre-
quencies below 500 cps. At higher
frequencies the continuous may fall a
constant distance below the interrupted,
The tracing width may or may not
become abnormally small, further add-
ing to possible confusion with type II.
At mid- and high frequencies there
may even be some overlap between C
and I. The distinguishing feature, how-
ever, occurring in both conventional
and fixed-frequency tracings, is the
gap between C and I at relatively low

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 ]erger: Bekesy Audiometry, Auditory Disorders 281

frequencies (100 to 500 cps). Type IV

tracings differ from type III tracings .
in that C ordinarily does not show a
precipitous drop over time. 20
The vast majority of Bekesy tracings -~
can be fitted into one of these four 40
categories quite reliably. There are,
~9 60 ,t
8O

2O I00
'10
125 250 500 IK 2K 4K OK
Frequency in cps
40
A

~9 60 i j
I
250 4K
80 I ,

I00 2O
125 250 500 IK 2K 4K 8K
Frequency in cps .r
=9 4 0
A

I I I 9~" 60
IK 4K
I I
80

20 I00
2 4 6 8 I0 12
40 yw | i.,.- w
Time in minutes

FIGURE 4. Conventional and fixed-frequency

80 Bekesy tracings in a 42-year-old male with left
Meniere's disease: A, conventional tracings; B,
fixed-frequency tracings. Loudness recruit-
IOO ment, as measured by the alternate binaural
2 4 6 8 I0 12 loudness balance test, was present at 1000 and
4000 cps but absent at 250 cps. T h e PB score
Time in mbutm at SL --- 25 db was 24%. Bekesy tracings
B are type II.

FtGUR~ 3. Conventional and fixed-frequency

Bekesy tracings in a 31-year-old female with
left otosclerosis: A, conventional tracings;
B, fixed-frequency tracings. Loudness re-
cruitment, as measured by the alternate
binaural loudness balance test, was absent at
250, 1000, and 4000 cps on the test ear. T h e
PB score at S L - - 2 5 db was 100%. Bekesy
tracings are type I.
however, a small number that, for one
reason or another, do not appear to fit
any of the four classic patterns. They
may be designated by the label 'ques-
tionable.' In some of these, excessive
tracing width (30 to 40 db) obscures

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 282 ]ourllal of Speech and Hearing Research

the relationship between C and I. In

others the conventional and fixed-
frequency results are contradictory,
and, in still others, high-pitched tinnitus
20
appears to invalidate the continuous
tracing. There is no unique common- .~ 4O t
t
6o
.1-

8O

20 'If'
I00
125 250 500 IK 2K 4K 8K
"i6 4O
,AN Frequency in cps
.! vv/v'
.I~ 60
I I
250 4K
80 . I

I00 2O
125 250 500 v\lK ?-K 4K 8K
Frequerfcy in cps
4O
_=
60 ~A AAAAL~
I 8
250 4K
8O

20 I00
2 '4 6 8 I0
.r
"rime in minutes
4o

1
B
"~ 60 FIGURE 6. Preoperative c o n v e n t i o n a l a n d

8O

I00
I~ fixed-frequency Bekesy tracings in a 51-year-
old female with a surgically confirmed left
acoustic neurinoma: A, conventional tracings;
B, fixed-frequency tracings. Loudness recruit-
ment, as measured by the alternate binaural
2 4 6 8 I0 12
loudness balance test, was absent at 250, I000,
"lime in minutes and 4000 cps. The PB score at SL = 25 db
was 58%. Bekesy tracings are type IV.

FIGt:RE 5. Preoperative c o n v e n t i o n a l a n d ality to these questionable tracings.

fixed-frequency Bekesy tracings in a 47-vear-
old female with a surgically confirmed right
acoustic neurinoma: A, conventional tracings;
B, fixed-frequency tracings. Loudness recruit-
ment, as measured by the alternate binaural
loudness balance test, was absent at 4000 cps.
The PB score at SL -- 25 db was 26%.
Bekesv tracings are type III.
They seem, instead, to reflect a general
lack of validity. T h i s category en-
compasses only a relatively small per-
centage of tracings and does not seem
to be unique to any particular etiology
or site of lesion.

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 Jerger: Bekesy Audiometry, Auditory Disorders 283

Illustrative Cases. Figures 3, 4, 5, and cps is quite dramatic. On the left, or

6 illustrate these four basic types of unaffected, ear, C and I are horizontal
tracings as they occur in actual sub- and overlap. On the right, or affected,
jects. Figure 3 shows Bekesy tracitlgs ear, however, I is stable but C drops
in a case of unilateral otosclerosis. Con- over 60 db to the limit of the equipment
ventional tracings are type I. The con- in less than 60 seconds.
tinuous tracing and the interrupted The fact that such a phenomenal
tracing overlap, and the width or ampli- drop should occur at all is remarkable.
tude of the continuous tracing remains That it should occur for a frequency
essentially normal (that is, about 10 as low as 250 cps is even more remark-
db). Fixed-frequency tracings are also able. Exploration at lower frequencies
type I. They show essentially horizontal in this subject revealed the same steadily
tracings, with the continuous and inter- progressive drop in the C trace at 100
rupted interweaving at all test fre- cps, the lowest frequency obtainable
quencies. from the equipment.
Figure 4 shows test results in a case Figure 6 illustrates the type IV trac-
of unilateral Meniere's disease. Here, ing in another surgically-confirmed
the Bekesy tracings are clearly type II. acoustic neurinoma. Neither conven-
On the conventional tracing C breaks tional nor fixed-frequency tracings
away from I at about 500 cps and re- show the steady decline typical of a
mains 10 to 15 db below I out to 8000 type III tracing. At the same time the
cps. Throughout this range the width relatively large gap between C and I
of the C tracing is quite small. The at very low frequencies clearly differ-
fixed-frequency tracing at 4000 cps entiates this from a type II tracing pat-
shows the characteristic initial drop of tern. In this particular ease the C
10 to 20 db in the C trace, followed by tracing width is relatively small, but
a relatively stable level. In this particu- other type IV tracings show a quite
lar case, the width of the C tracing is normal width.
relatively small, but this is not invari- Distribution of Patterns. In order to
ably the case in type II fixed-frequency study the generality of this apparent
tracings. relationship between type of Bekesy
Figure 5 shows Bekesy tracings in tracing and site of lesion within the
a subject with a right acoustic neuri- auditory mechanism, all Bekesy audio-
noma. Here, one sees a relatively ex- grams obtained on subjects with hear-
treme example of the type III Bekesy ing loss in the Northwestern University
tracing. On the conventional tracings Hearing Clinics were categorized ac-
C never does overlap I. Even at 125 cps cording to type.
it runs about 35 db below I, and the Table 1 shows the number of subjects
disparity increases with frequency. At within each of the four categories for
1000 cps the C trace has dropped to various etiological subgroups. In the
the limit of the equipment, whereas case of the acoustic neurinoma group,
the I trace is at a hearing level of about classification is based on surgical con-
10 db. firmation. All other classification by
The fixed-frequency tracing at 250 subgroup is based on the medical

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 284 Journal of Speeclo and Hearing Researcb

TXBLE 1. Distribution of the four Bekesy types (I, II, III, IV) and of unclassifiable tracings (?) accord-
ing to presumed etiology of the hearing loss in 434 subjects.

Etiology Tracings Total

I II III IV ?

Normal Hearing 33 0 0 0 0 33
Otosclerosis 50 2 0 0 2 54
Otitis Media 6 0 0 0 0 6
Other Conductive Loss 9 0 0 0 0 9
Meniere's Disease 4 26 0 1 1 32
Noise Induced Loss 7 15 0 0 0 22
Acoustic Neurinoma 0 0 6 4 0 10
Unknown Sensorineural Loss 54 119 0 12 10 195
Presbycusis 24 15 0 2 3 44
Otosclerosis Plus Sensorineural Loss 2 10 0 1 0 13
Sudden Onset of Loss 1 1 10 4 0 16

Total 190 188 16 24 16 434

diagnosis supplied by staff members of pathology, suggests a fairly strong re-

the Department of Otolaryngology of
the Northwestern University Medical
School.
Included in this series of 434 ears are
69 presumably conductive lesions pri-
marily due to otosclerosis and otitis
media, 54 presumably cochlear lesions
due to Meniere's disease and prolonged
noise exposure, 10 known eighth nerve
lesions due to acoustic neurinoma, and
four subgroups in which the site of
lesion is less well understood. One
of these, the sensorineural unknown
group, constitutes the largest single
subgroup with 195 subjects. An ad-
ditional 16 subjects from this group
are treated separately because of a
history of relatively sudden onset of
loss in one ear, without subsequent
fluctuation. Finally, there are 44 sub-
jects with presbycusis, and 13 subjects
with advanced otosclerosis accompanied
by secondary sensorineural loss.
Examination of subgroups in Table
1, for which there is relatively good
agreement concerning the locus of
lationship between type of Bekesy
tracing and site of lesion. In lesions of
the middle ear (otosclerosis, otitis
media) the type I tracing predominates.
In cochlear lesion (Meniere's, noise-
induced) the type II tracing predom-
inates although some fall into the type
I category. No Meniere's case ever
showed a type III tracing. In eighth
nerve lesion (acoustic neurinoma) type
III and type IV tracings predominate.
No acoustic neurinoma ever gave a
type II tracing.
In view of this compelling relation-
ship, the results of the analysis in etio-
logic subgroups of more obscure origin
are of interest. As might be expected,
the majority of sensorineural unknowns
are type II, suggesting cochlear lesion.
This is also true of otosclerosis ac-
companied by secondary sensorineural
IOSS.
Almost one-third of the sensorineural
unknowns, however, show type I trac-
ings and 12 show type IV tracings.
This relatively ill-defined group may

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 ]erger: Bekesy Audiometry, Auditory Disorders 285
possibly include at least two and pos-
sibly three distinctly different kinds
of sensorineural loss. In presbycusis the
situation is even more provocative.
Here, there are actually more type I
than type II tracings.
Contrary to expectation, hearing loss
of sudden onset is primarily type III
and type IV, suggesting eighth nerve
rather than, or perhaps in addition to,
cochlear lesion.
Discussion
In certain respects the present results
do not seem to be in very good agree-
ment with the findings of some previous
investigators. Lundborg (21), for ex-
ample, apparently observed nothing
like the present type III tracings in any
of his 21 cases of retrocochlear lesion.
His Bekesy thresholds were apparently
in good agreement with the results of
conventional threshold audiometry. Nor
do Palva's (27) results on 39 cases agree
with the present findings in fixed-fre-
quency tracings. After four minutes of
threshold tracing, there was a change
of more than 10 db in only one of
Palva's 33 perceptive losses. He con-
eluded (26) that 'an abnormal loss in
sensitivity is not common enough to
give reliable clues to differential diag-
nosis.'
The present findings are far more
encouraging. They show clear evidence
of pathological adaptation (types II,
III, and IV) in 226 of 332 sensorineural
losses (68 % ). Furthermore, the manner
in which pathological adaptation ap-
pears to be related to site of lesion sug-
gests that Bekesy audiometry has the
potential to become an exceedingly
sharp tool in the differential diagnosis
of hearing disorders.
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Finally, it should be observed that
the present results are in accord with
the previous findings of Dix and Hood
(4), Kos (16), Lierle and Reger (19),
and Yantis (37).
It may be appropriate to cite two
possible bases for the lack of agreement
between the present results and the
previous findings of Lundborg and of
Palva. First, the discrepancy may be
due to a simple artifact of instrumenta-
tion. Lundborg (21) states that, in his
Bekesy audiometer, attenuation changed
in 2-db steps, and Palva (24) states that
his audiometer changed in 1-db steps.
It may be that the momentary transient
energy introduced by each abrupt
change in level made their continuous
stimuli more like the interrupted than
the continuous stimulus used in the
present study. In the Bekesy audiom-
eter used in the present experiment,
successive changes in level were less
than 0.25 db. This distinction between
virtually continuous change and change
in small, discrete steps may very well
be an exceedingly important variable.
Jerger and Bucy (13) showed, for ex-
ample, that only very brief silent inter-
vals (10 to 20 msec) between successive
short tones were sufficient to maintain
a stable horizontal tracing in a patient
who readily demonstrated a type III
tracing under continuous stimulation.
Second, it should be observed that
with the exception of Dix and Hood
(4), who used different instrumenta-
tion, no previous investigator, to the
author's knowledge, has compared the
continuous threshold tracing with the
corresponding interrupted threshold
tracing. Apparently, all previous work-
ers have employed only a continuous
stimulus for either conventional or
 286 Journal of Speech and Hearing Research
fixed-frequency tracing. The present
results, however, suggest that the com-
parison between C and I is the key to
fruitful interpretation of Bekesy trac-
ings. Type III continuous tracings are,
to be sure, so dramatic that they are
easily recognized, but they are com-
paratively rare. In the vast majority of
cases showing pathological adaptation
(type II) the magnitude of the effect
is not great (5 to 20 db). It occurs,
furthermore, so rapidly that, if one
makes measurements only at one minute
intervals and seeks only a shift in the
continuous threshold, he is likely to
observe very little evidence of dra-
matic adaptation over time. When the
continuous tracing is compared with
its interrupted counterpart, however,
the abnormality is readily recognized.
Another aspect of interpretation that
deserves re-emphasis is the relationship
between pathological adaptation and
frequency. Again, when marked adap-
tation occurs (type III), it may
generally be observed at almost any
frequency with measurable hearing.
But such tracings are, again, compar-
atively rare. In the more commonly
encountered type II tracing, pathologi-
cal adaptation is very definitely a high-
frequency phenomenon. The manner in
which the difference between C and I
relates to frequency is, in itself, a quite
stable characteristic of the over-all type
II pattem.
Summary
A qualitative analysis of 434 Bekesy
audiograms suggests that most tracings
can be placed into one of four cate-
gories. The basis for categorization is
the relationship between tracings of
periodically interrupted and continu-
ous tonal stimuli. Lesions of the middle
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ear are characterized by one relation-
ship, lesions of the cochlea by a second,
and lesions of the eighth nerve by a
third and fourth.
Summario in Interlingua
Un analyse qualitative de quatro
centos trenta-quatro audiogrammas de
Bekesy suggere clue le major parte del
audiogrammas pote esser placiate in
un de quarto categorias. Le base del
categorisation es le relation inter audio-
grammas de stimulos tonal que es inter-
rupte periodicamente e stimulos tonal
que es continue. Lesiones del aure medic
demonstra un reIation, lesiones del
coelea demonstra un secunde, e lesiones
del nervo octave un tertie e quarte.
Editor's note: For the interest of Journal
readers, the author has prepared the above
Summary in Interlingua, an international aux-
iliary language developed by the International
Auxiliary Language Association, 420 Lexing-
ton Ave., New York 17. As of 1960, 17 Amer-
ican and five foreign journals are printing
summaries in Interlingua; two American
journals are being edited completely in Inter-
lingua; seven international congresses thus far
have furnished summaries of all papers in
Interlingua. The core of this language is the
vast number of internationally identical tech-
nical terms already in existence in the various
national tongues of western culture. A recent
UNESCO survey indicated that of all existing
languages, Interlingua has the widest range
of immediate intelligibility. English is second.
The Journal will print other summaries in
Interlingua when these are provided by the
authors.
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